After losing his arm in a car crash six years ago, and suffering excruciating phantom limb pain, Michael Fine says he became addicted to opioid painkillers and suicidal.

Along with support from his family and friends, Fine credits medical marijuana as another factor in his recovery.

"Cannabis has helped me regain my life back," said Fine, a 49-year-old Glenview resident who was co-chair of the state's medical marijuana advisory board.

Now, one year this week after the first legal medical marijuana hit the market in Illinois, patients like Fine say the program is proving itself.

"The sky hasn't fallen; no one has junkies hanging out in their yard," Fine said. "Patients purchase their cannabis and go home. … It's only going to help people, not hurt people. People are seeing that now."

Despite such anecdotes, broader data and randomized clinical trials of the medical use of marijuana remain very limited. Opponents of the program continue to raise warnings about negative effects, harm from smoking, use by minors and increasing traffic crashes.

The issue may be at a tipping point nationally, as voters go to the polls Tuesday in five states to decide whether to allow recreational use of the drug, and four other states have ballot measures on medical marijuana.

Antonio Perez / Chicago Tribune

Michael Fine, a medical marijuana user and former member of the state medical marijuana advisory board, demonstrates a yoga move with his dog Bo nearby at his Glenview home on Nov. 7, 2016. Fine lost his left arm in a car crash six years ago and suffers severe pain from phantom limb pain.

Michael Fine, a medical marijuana user and former member of the state medical marijuana advisory board, demonstrates a yoga move with his dog Bo nearby at his Glenview home on Nov. 7, 2016. Fine lost his left arm in a car crash six years ago and suffers severe pain from phantom limb pain. (Antonio Perez / Chicago Tribune)

Since the first dispensaries opened in Illinois on Nov. 9 of last year, officials say, there have been very few overt problems with the program. Police say they have not seen any significant complications, and not a single patient has had his or her license rescinded for diverting the drug to illegal uses.

However, calls to the Illinois Poison Center for marijuana exposure have increased this year, to 21 children and two adults, from 13 children and no adults last year. In the four preceding years, the annual number of cases was five or fewer.

It's not known whether those cases involved medical marijuana, and they varied in seriousness, but all the patients recovered, said Carol DesLauriers, director of the poison center.

The numbers are very small compared with the 74,000 calls the center fields a year, most for painkillers and prescription anti-anxiety drugs.

In Illinois, after a slow start, the medical marijuana program has grown steadily each month but remains relatively small, at about 12,000 patients who have spent about $28 million. Under the state law, they may not smoke it in public, may not share it with anyone and may not drive while high. Employers still have the right to fire employees for marijuana use.

This summer, Republican Gov. Bruce Rauner signed a compromise law that added post-traumatic stress disorder and terminal illness as qualifying conditions, and extended the medical marijuana program until mid-2020, while allowing doctors to certify that a patient has a qualifying condition without recommending marijuana.

Because of that, along with a new law that decriminalizes possession of small amounts of the drug, the marijuana advocacy group NORML gave Rauner a grade of B- for his handling of marijuana laws.

Still, the program stands at a critical juncture. In an unusual step, courts have ordered the state to add or consider adding seven new qualifying medical conditions to the list of 41 already approved. The office of Illinois Attorney General Lisa Madigan, a Democrat, is appealing those orders to avoid expanding the pool of patients.

If those conditions — including common ones like migraine headaches, osteoarthritis and intractable pain — are ultimately allowed, they would make marijuana available to many more people.

Meanwhile, preliminary data on the effects of such programs is being closely watched by advocates and opponents alike.

In Illinois, while there is no overall program to track the results of medical cannabis use, the state does track emergency department visits due to cannabis use, abuse and dependence. The total number of such cases for the first half of this year is on a pace to roughly equal the number of cases for last year, though the Department of Public Health cautions that seasonal variations may distort such comparisons.

The number of emergency department visits increased in each of the previous three years, though medical marijuana has only been on the market a year, so the trend preceded the program.

"There's a lot of room for improvement," said Dan Linn, head of the marijuana legalization advocacy group NORML in Illinois. "Obviously, we'd like to see more conditions added."

While state law allows qualifying patients to only buy marijuana from licensed dealers, marijuana possession remains illegal under federal law. The U.S. Drug Enforcement Administration this year kept marijuana as a Schedule 1 controlled substance, which means the agency considers it as dangerous as heroin and LSD, with no accepted medical use and a high potential for abuse.

It's that potential for abuse that concerns specialists like Dr. Kirk Moberg, medical director of the Illinois Institute for Addiction Recovery in Peoria. While the vast majority of people who smoke marijuana will not become dependent, a small percentage will, he warned.

Although he has not noticed an increase this year, he said the authorization of marijuana for medical use legitimizes it in the minds of some abusers and can lead to an increase in use by adolescents.

"It sends a message to our young people that there's not a problem with this drug and it's perfectly safe," he said.

Like many health officials, he would prefer to see marijuana undergo more randomized trials for review by the U.S. Food and Drug Administration, like any prescription drug. While prescription narcotics kill thousands of people a year, and it's virtually unheard of to fatally overdose on marijuana, Moberg said FDA approval would help doctors prescribe the proper dose and use, rather than offering it for a random list of conditions.

One other area of concern that arose in Illinois' inaugural year involves driving while high. AAA reported this year that fatal car crashes involving marijuana doubled in Washington state from 2013 to 2014, after it legalized recreational marijuana.

Dr. Guohua Li, professor of epidemiology at Columbia University's Mailman School of Public Health and director of the school's Center for Injury Epidemiology and Prevention, said the frequency of fatal auto accidents in which drivers tested positive for marijuana has nearly quadrupled since 1999, to about 15 percent of all fatal crashes.

Marijuana can stay in the body after its "high" has worn off, and alcohol remained a factor in about 40 percent of crashes, so it's unknown how large a role marijuana played, but Li said there is a nationwide trend toward more drugged driving, with both legal and illegal drugs.

Researchers also found that states that allowed medical marijuana had fewer drivers who tested positive for opioids, though Li cautioned that the evidence was weak and did not prove one caused the other.

At The Healing Clinic in Chicago, which helps patients sign up for medical marijuana, founder Feliza Castro said she's seen many severely debilitated patients get the help they need, and the state has sped up the process for approval.